Read Explain Pain by David Butler and Lorimer Moseley text version

`Explain Pain'

Reviewed by Mick Thacker, MSc MCSP Grad Dip Phys MMACP Division of Physiotherapy and Neural Injury and Repair Group, King's College London Authors David Butler and Lorimer Moseley, Art by Sunyata Published by Noigroup Publications, Adelaide, South Australia ISBN 0 9750910, 130 pages, AUD $70.00

(+ $7 GST in Australia)

Explain pain - what an undertaking! I know of few people brave enough, determined enough and perhaps most importantly crazy enough to undertake such a massive venture. David Butler and Lorimer Moseley obviously fulfill these criteria, as the end result of their endeavours is a truly remarkable and unique book. The impact of this book begins the moment you lay eyes on it, the front cover is a bright abstract amalgamated depiction of the authors. The size, binding and layout of this book are unique and help to facilitate the concepts and messages the authors wish to convey. The artwork is informative, detailed, `wacky' and occasionally disturbing but it continually conveys and illustrates the key messages that David and Lorimer have outlined in the text. The book is split into five well-conceived sections taking the reader on a journey through the topic of pain. Section 1 sets the scene. It places pain into a 21st century context. The take home messages are there from the outset. The key concept of pain as a threat that the brain perceives and responds to is begun here. The authors manage to steer the reader away from outdated concepts and beliefs in a relaxed, none threatening manner. They engage the reader with fabulous pain stories (the artwork works wonderfully with the text). This section, in common with the others, ends with a concise easy to read summary of all the salient points and aids the reader to quickly access and revise the key points from the preceding text. Section 2 focuses on the detection, transduction and transmission of nociception. The authors are to be particularly congratulated for conveying all this information in a manner that never reverts back to outdated concepts seen in many texts. They cleverly introduce concepts such as modulation of pain so that the reader is provided with a good working knowledge of not only how pain is felt but also how it is got rid of. Difficult concepts are presented clearly without losing scientific accuracy. I particularly love the use of the graffiti language to explain Melzack's Neural Matrix theory - this is book has real street cred! The third section deals with pain from different tissues and the relationship between injury, inflammation and repair. The diagram on page 47 is superb, it offers a simple representation of the relationship between pain, healing and tissue/ neural mechanisms. In common with many of the images in this book it clearly demonstrates vital information not only for the patient but also for the therapist. The language continues to be engaging and entertaining. The authors have delivered to us a new name for the intervertebral disc- the Living Adaptable Force Transducers (L.A.F.T.). They present credible reasons for suggesting this name change, in addition to the fact that: "between the 5th lumbar vertebra and the pelvis is the `last LAFT'"! Essential information is given for all sources of somatic pain. The concepts of peripheral neurogenic/neuropathic pain are introduced to the reader within a consistent construct with the previous sections of the book.

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`Explain Pain'

Reviewed by Mick Thacker, MSc MCSP Grad Dip Phys MMACP Division of Physiotherapy and Neural Injury and Repair Group, King's College London Authors David Butler and Lorimer Moseley, Art by Sunyata Published by Noigroup Publications, Adelaide, South Australia ISBN 0 9750910, 130 pages, AUD $70.00

(+ $7 GST in Australia)

Section 4 focuses on the role of the central nervous system in the production and maintenance of pain. The primary focus is on the mechanisms of sensitisation and neural plasticity. This section pulls the rest of the book together in my opinion and I envisage many patients (and therapists) having a `eureka' moment whilst reading it. The role of emotion and cognition are integrated into the bigger picture that emerges from this section. Other associated systems such as the immune system are dealt with, as is the effect of pain on movement and motor recruitment. Section 5 looks at models of pain management. It does so in a modern, balanced and evidenced manner. There is something for everyone with all the key strategies outlined. There is an avoidance of jargon; it is a pleasure to not have to read about the bio-psychosocial or the biomedical models of healthcare but rather to hear about the best and most wise actioned approaches to the individual with pain. Having already heaped much praise upon the diagrams in this book it is sufficient to say that they are at their best in this section. The interpretative representation of Vlaeyan and Crombez's work on page is 101 is one of the highlights of the book. The final section offers a four-tool strategy for the management of pain. Tool 1 focuses on the need for education and understanding of pain and it's manifestations. It challenges accepted dogma in a thought provoking and balanced manner. Tool 2 continues on from tool 1, it challenges the widely held view that hurt equals harm. Importantly, it not only challenges this construct but highlights the negative consequences associated with reasoning of this kind. It further suggests strategies that can be employed to begin to `get to know one's pain' and places an emphasis on healthy behaviours. Tool 3 focuses on how movement and exercise can be dosed for the individual. The concepts of pacing and graded exposure are explained in a no-nonsense easy to understand way, again the diagrams reinforce the messages conveyed in the text. Tool 4 is entitled `Accessing the virtual body', it draws upon the construct assembled throughout the book that sees pain as a threat-response phenomena perceived and modified by the nervous system. It details a series of simple exercise and `add-ons' that can be used in a daily management regimen to manage pain. The authors began the book with four aims: to assist health professional explain pain; to enable people in pain to understand more about pain; to assist people in pain and lastly to outline modern models of management. I believe that they have achieved these aims admirably. If that were not achievement enough they have done so with unequalled empathy, humour and intelligence. They are to be congratulated, this is an excellent book. You and your patients need (and deserve) this book!

Mick Thacker, MSc MCSP Grad Dip Phys MMACP Division of Physiotherapy and Neural Injury and Repair Group, King's College London

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